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How Anti-Aging Drugs Could Help Medicare

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When Google recently announced that it had formed a company, Calico, to tackle the challenge of aging and associated diseases, it said little about what the new spinoff would do. But Google CEO Larry Page gave a hint when he was quoted as saying that curing cancer wouldn't be "as big an advance as you might think," adding that he'd learned to his amazement that it would add only about three years to life expectancy.

This is precisely the point that scientists who study aging have made in recent years to support increased spending on anti-aging research. Even if you could eliminate a major disease of aging like cancer, they note, the gain would be limited because such ills mainly afflict people in later life when they face soaring risks of many dire diseases—curing cancer would just mean that more people wind up with heart failure or Alzheimer's disease.

That calls for a radical new approach in medical research, say gerontologists: Pursuing interventions that delay aging and thus push off all diseases of aging at once.

Now a new study has added weight to this argument—and expanded on Page's point—by showing that delayed aging could help prevent Medicare costs from spiraling out of control as the population ages. By keeping older adults healthier and, in effect, biologically younger, drugs or other interventions that delay aging would lower older adults’ per-capita medical costs. It would also justify gradually raising the eligibility ages for receiving Medicare benefits, the study suggests. That would go a long way toward preventing sky-high health-care costs that lead to economically disastrous budget deficits and federal debt.

All this belies the negative views surrounding anti-aging research. In fact, when people are asked in surveys whether they'd want to live significantly longer with the help of anti-aging drugs, most tend to say no. That's largely because they envision themselves simply spending more time in elderly decline. But anti-aging research doesn't support that bleak view. In fact, extending the lives of animals via delayed aging (the possibilities include very-low-calorie diets, gene mutations, and a drug called rapamycin) doesn't prolong morbidity at the end of life. Instead, it has lengthened the period of good health before the onset of elderly frailty, reducing the risks of old-age diseases at every age.

A number of studies also suggest that animals with delayed aging often experience abbreviated terminal declines. That means anti-aging drugs should both increase the fraction of life spent in good health and help prevent end-of-life care from racking up ruinous medical expenses.

The new study, published in Health Affairs by researchers at the University of Southern California, Harvard, Columbia, and the University of Illinois at Chicago, assumes that it will be possible by 2030 to develop agents that increase human life expectancy at age 51 by a modest 2.2 years—a person at 51 could expect to live to 89 instead of about 87. It also assumes that most of the added life years would be spent in good health. By expanding the period of good health before the onset of elderly frailty, the modestly delayed aging assumed by the study was projected to increase the number of non-disabled older U.S. adults by 15% by 2060—more than 11 million would be relatively healthy instead of disabled.

At the same time, the delayed aging was predicted to expand the number of Americans aged 65 and over in 2060 by 6.9%, to 113 million from the 106 million currently expected. In light of this increase, the study suggests that it would make sense to gradually raise the eligibility age for Medicare from 65 to 68 over the next two decades—after all, delayed aging would effectively make people younger than now indicated by their chronological ages. Otherwise anti-aging interventions would boost overall government health-care spending because of the greater number of elderly people receiving benefits, even though they'd be healthier.

Similarly, the study suggests that if interventions to delay aging were available it would make sense to raise the normal retirement age for Social Security from 67 (as of 2030) to 68.

The study doesn't address many of the burning issues about anti-aging research, such as how much it would cost to develop drugs or other interventions that delay aging, how they would be made available, and when they might arrive. But it does argue that modestly delayed aging would likely yield significantly greater societal benefits than attempting to increase life expectancy, as we now do, by attacking old-age diseases one at a time with increasingly costly therapies that are often applied when it's too late to do much good. Indeed, despite the many billions we now spend on disease-specific research, "disabled life expectancy [remaining years of life spent with disabling disease] is now rising faster than life expectancy, leaving the number of years that one can expect to live in good health unchanged or diminished," said Dana Goldman, the study's lead author and a health economist at the University of Southern California.

In contrast, anti-aging medicine, argued the study, would offer a "highly efficient way to forestall disease, extend healthy life, and improve public health” by addressing the shared root cause of all diseases of aging: the aging process itself. Assuming that an extra life-year is worth $100,000, the delayed aging assumed by the study would yield a "social benefit" of about $7.1 trillion over the next 50 years, according to its analysis. Not surprisingly, its authors concluded that investing in research to slow aging "should become a priority."

It remains to be seen whether executives at Google's new venture will agree with their reasoning—it has proved a hard sell with policy makers and the public. But it does sound as if the boss gets it.

 

 

The views expressed are those of the author and are not necessarily those of Scientific American.

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